Comprehensive primary care is essential to good health,
wellness and needed medical care during our elder years. It is critical to
Aging Gracefully.
In the last
few
posts
I wrote that Aging Gracefully physically requires attention to
lifestyle/behaviors to assure good nutrition, plenty of exercise, reduced
stress, no tobacco and – for preserving cognitive function – intellectual
challenge and social engagement. That is what each of us needs to attend to but
we also need a good primary care physician (PCP) to assist us on our journey.
That PCP needs to have adequate time to listen and listen fully.
The
Erickson Living retirement
communities have developed an approach that appears to work well for its
residents. Let me use it as an example. The fundamental concept is to assure
that everyone has comprehensive primary care. T
he Erickson leadership learned that healthcare was of paramount
importance to their residents. A strong program would be good unto itself but
also a strong marketing attraction. After substantial study and trial and error
they set the resident/patient number per doctor at a remarkably low 400 for
their in-house salaried PCPs. They found that this 400:1 ratio was the ideal
number of elderly geriatric residents per doctor in order to assure the
quality, humanistic and integrative approach to care desired. (For comparison,
the usual patient to PCP ratio is about 3000:1.) They have clearly demonstrated
that this approach to primary care with a low number of patients per doctor
(and a team that functions akin to a medical home) not only gives superior care
but that it results in much reduced total
costs of health care overall.
According to the
medical director, Matthew Narrett, MD, residents can have same or next day
appointments for as long as needed,
they are offered extensive preventive care (“It is never too late to
prevent,”) the PCPs are well versed in
gerontology issues and there is a strong
commitment to listening. Some of the results of this approach: Chronic
illnesses can be managed usually quite successfully without the need for
referral to specialists but, when needed, specialists are readily available
(many conduct office hours on site on a rotating basis eliminating the need to
travel to a distant office). Hospital admissions are down absolutely and
markedly so in comparison to equivalent groups of elderly individuals. The
length of stay in the hospital for those who must be admitted is lower and the
30 day unanticipated readmission rate has consistently been below 11% (the
national rate is about 20%plus) despite the average age of their residents
being about 82, i.e., one would expect their average rate to be higher than the
national rate for Medicare-covered individuals overall. Dr Narrett reported
that resident satisfaction was very high. I confirmed that when I was at the
Charlestown community to give a talk organized by residents. With no staff
present, I asked the 90 or so attendees their impression of the healthcare
program. I received only positive accolades.
At the Charlestown
and Riderwood communities where I have toured (and other locations) the onsite
clinic includes not only the PCPs, but one or more nurse practitioners, a
podiatrist, and a suite for a visiting dentist, for an optometrist and for an
audiologist. The podiatrist is full time (at the larger communities) but the
others are there commensurate with the need. Various outside medical and
surgical specialists (e.g., cardiology, gastroenterology, dermatology,
orthopedics, etc.) offer office hours on site on a scheduled basis. The clinic
has an on-site nurse to coordinate special needs such as preparing for surgery,
returning to the community from the hospital, transferring to assisted living,
arranging in-home special needs care, etc.
A Medicare
Advantage Plan is also offered by Erickson Living to residents of their group
of 18 continuing care retirement communities. In the Erickson plans
(administered through United Healthcare)
one can choose the on-site PCPs or continue with one’s own PCP, can access a
wide range of specialists when necessary, can use most any hospital, can be
driven to most off-site doctors’ offices at no cost, etc. Unlike Traditional
Medicare where one must spend three days in the hospital in order to be
eligible for Medicare to pay for the first 100 days of residential skilled
nursing care, this Advantage plan waives
the required three day stay. In other words, if the resident would benefit, the
doctor can make the decision and can arrange immediate referral to their on
campus site. This of course eliminates a very costly and potentially hazardous
hospitalization. There is also an on-site benefits specialist to assist
residents with their questions. The most common plan costs substantially less
than one might pay for both Medigap and Part D policies yet it includes greater
benefits (e.g., basic dental) with few co-pays and no deductibles.
Older individuals
perhaps even more than others need comprehensive primary care. It is a critical
aspect of Aging Gracefully. Unfortunately, most older people do not have the
benefit of a PCP who can spend the time they need.
My takeaway from
the Erickson model is that when the PCPs are allotted the needed time and can
listen and think, the care is excellent, satisfaction is strong and the total
costs come down substantially. It also means that the PCP can get back to
relationship medicine where trust
builds and healing
is possible.
I am not
advocating for Erickson Living or that you move to a retirement community but my
recommendation is definitely that you seek out a PCP who can and will offer the
time you need to assure good healthcare so that you can Age Gracefully.
Disclaimer – I
have no financial relationship with Erickson Living. It is used solely as an
example to demonstrate the utility and value of a PCP (along with a well-functioning
team) who can offer each patient the time necessary for comprehensive primary
care.
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